Nutritional status of indigenous children from the Alto Xingu in 1980 and 1992 and follow-up of weight and height from the first through the fourth years of life

This study focused on the under-five population of the Alto Xingu region in Brazil, with the following objectives: (1) to evaluate height and weight increment from the first through the fourth years of life and (2) to compare nutritional status in 1980 and 1992. Height and weight increases were evaluated in 81 children. Weight and height were measured in 264 children evaluated in 1980 and in 172 in 1992 (< 10 years of age). Median Z-scores in the first and fourth years of life, respectively, showed: (1) a decrease in weight-for-age, (-0.12 in the first year and -0.51 in the fourth year of life; p = 0.002); (2) a decrease in weight-for-height (+1.31 and +0.08; p < 0.001); (3) an increase in height-for-age (-1.50 and -0.94; p < 0.001). Median Z-scores in 1980 and 1992 showed: (1) no change in weight-for-age (-0.61 in 1980 and -0.62 in 1992; p = 0.90); (2) no change in weight-for-height (+0.27 and +0.34; p = 0.10); and (3) a decrease in height-for-age (-1.04 and -1.22; p = 0.02). Height-for-age increased and weight-for-height decreased between the first and fourth years of life. A decrease in height-for-age was observed from 1980 to 1992, demonstrating the importance of nutritional surveillance among the population of the Alto Xingu.     

Nutritional and immunisation status, weaning practices and socio-economic conditions of under five children in three villages of Bangladesh

A total of 479 children aged 6-60 months (male/female, 240/239) were studies during 1991 to 1992. Weight for age, height for age (mean +/- SD) were 72 +/- 11%, 90 +/- 7 and 87 +/- 10% of NCHS median respectively. According to Gomez classification, 96% of children had varying degrees of protein energy malnutrition (PEM) (28.4% mild, 58.2% moderate and 9.2% severe). According to Waterlow classification 84% were stunted(36% mild, 33% moderate and 15% severe) and 67% were wasted (47% mild, 18% moderate and 2% severe). Of all children 368 (77%) received BCG and 439 (82%) received partial or full dose of DPT and Polio vaccines. Among children aged 13-60 months 75% received Measles vaccine. Weaning food was started at (mean +/- SD) 8 +/- 4 months. Low household income, parental illiteracy, small family size (< or = 6), early or late weaning and absence of BCG vaccination were significantly associated with severe PEM. Timely weaning, education and promotion of essential vaccination may reduce childhood malnutrition especially severe PEM.     

Infant malnutrition and associated maternal factors in a secondary city south of Benin, Ouidah]

BACKGROUND: The aim of this study was to find the needs and priorities for interventions to improve children's nutritional state in a secondary city in Bénin. It addressed the issues of the magnitude and distribution of infant malnutrition and related maternal factors. It also aimed to identify an easy to use and low cost, but valid, technique to diagnose malnutrition in children. METHOD: First of all, the prevalence of infant malnutrition was assessed with a representative sample of 492 children aged less than 36 months, in all four communities of the city. Then the sensitivity and specificity of arm circumference were studied and the associations between the children's anthropometric indices were assessed. Secondly in a sub-group of 200 couples of mothers and children, an analysis was conducted to show the links between the indices of mothers' nutritional status, some of their social and economical variables, and the children's anthropometric indices. RESULTS: The prevalences of wasting and stunting and all other forms confounded among children aged 0-3 years were respectively 5.7%, 22% and 25.9%. They represented 44.7% for the arm circumference. Wasting was more prevalent among children aged 6-23 months (9.6%) than those aged less than 6 months (1.1%) and those of 24 to 36 months (5.2%). The boys had a higher prevalence of stunting (25.1%; p = 0.049) than the girls (18.1%). The correlation between children arm circumference and their indices weight/height, weight/age and height/age were all significant (p < 0.001), but they were higher for weight/age (r = 0.48) and weight/height (r = 0.36) than for height/age (r = 0.30). Low, but significant correlation (r ranged from 0.17 to 0.25) were observed between anthropometric indices of mothers and children. Mothers' instruction level had a tendency to be associated positively and significantly with children z-score weight/height. The effect of socio-economic level on children's nutritional status was significant only at p < 0.10. Unlike the condition observed in the big cities of under-developed countries in general, the central area of Ouidah was more affected by infant malnutrition than peripheral area recently urbanized. CONCLUSIONS: Infant malnutrition appears to be a really public health problem in this town and children at weaning age are more affected. The interventions to improve children's nutritional status must concern, not only children with malnutrition, but also their mothers. Those interventions must also improve mother's knowledge and practices about weaning foods and their instruction and socioeconomic levels. The cut-off-point 12.5 cm of arm circumference seems to be more appropriate to diagnose wasting among children aged less than 12 months; 13.5 cm is better for 12-36 months aged children.     

The relationship of growth failure (chronic undernutrition) to the prevalence of clinically severe protein-energy malnutrition and to growth retardation in protein-energy malnutrition.

A total of 72 of 276 children from a rural Mexican village were chronically undernourished as judged by their growth failure between 6 and 36 months of age. Fourteen of the 72 and five of the remaining 204 children developed clinically severe protein-energy malnutrition (PEM) as judged by clinical signs other than weight or length. This amounted to an 8-fold higher prevalence of PEM in the group of children with growth failure. When children were grouped into quartiles of length at 6 months by sex, quartile was not related to the subsequent occurrence of PEM or to the age when PEM developed. However, analysis indicated that the growth of children with PEM and growth failure had slowed relative to their quartiles before PEM developed; they were also retarded according to the Harvard standards. The children with PEM were then compared to others with a similar growth history (growth failure, no growth failure) who never developed PEM. PEM children did not differ significantly in over weight or length and displayed a significant difference in upper arm muscle circumference at only one age. The 14 with growth failure and PEM had poorer overall growth, including arm muscle circumference, than the five with PEM and no growth failure.     

Anthropometric measurements,deficiency signs and their relationship under drought conditions

In October-November 1987 in India, the Desert Medicine Research Centre in Jodhpur conducted a rapid anthropometric survey of 555 preschool children in 4 districts of Rajasthan which had been severely affected by drought (Jodhpur, Jalore, Nagpur, and Barmer districts) to determine the association between anthropometric measurements and various nutritional deficiency signs and infections. Based on weight for age, 82.3% of the children were undernourished. 13.3% of all children were severely malnourished (grade III undernutrition). Anemia, protein energy malnutrition (PEM), and upper respiratory infections occurred significantly more often as one digressed from the normal nutrition grade. These 3 conditions were also closely linked to weight status. Based on height for age, 62.4% of the children were chronically undernourished. 11.9% of all children were severely so. PEM was the only deficiency sign or infection associated with height status (6.2% of children with normal nutrition had PEM vs. 15.% for grade I undernutrition and 34.8% for grade II undernutrition; p .001). Vitamin A deficiency, anemia, and PEM occurred more frequently as one went from normal nutrition to grade II undernutrition based on fat fold at triceps (FFT) measurements. PEM and upper respiratory infections were significantly associated with weight for height status. Weight correctly identified 84% of all nutritional deficiency signs and infections. The corresponding figures for height, FFT, and weight for height were 64.2%, 75.4%, and 31%. Thus, weight was the most sensitive screening measurement in identifying nutritional deficiency signs and infections. Based on weight alone, the odds ratio of undernourished children developing Vitamin b-complex deficiency, PEM, and upper respiratory infections was 1.58, 3.25, and 1.77, respectively. Weight for height was the most specific screening measurement (88.2% vs. 44.7% for height, 29.3% for FFT, and 26.1% for weight).     

Protein-energy malnutrition: the nature and extent of the problem

The paper begins by describing how the names 'protein malnutrition' and 'protein-energy malnutrition' (PEM) developed from the local name 'Kwashiorkor'. The central feature of severe PEM is oedema; the classical theory suggests that the cause is a deficiency of protein, but other factors are also involved. In the community mild-moderate PEM is defined by deficits in growth. A distinction has to be made between low weight for height (wasting) and low height for age (stunting), Stunting in particular affects some 50% of children worldwide. Its causes and consequences are briefly discussed. In adults, severe PEM has essentially the same features as in children and includes the condition'famine oedema' or 'hunger oedema'; there are again controversies about its cause. In the community, chronic malnutrition is assessed by the body mass index (BMI) (Wt/Ht(2)). Grades of deficiency have been defined and examples are given of functional consequences of a low BMI. Secondary malnutrition differs from primary PEM because of the role played by cytokines and other concomitants of illness or injury. The importance is emphasized of chronicity or duration in determining the clinical picture.     

Pediatric patients malnutrition and its relation to hospitalization times and causes

The Protein Energy Malnutrition (PEM) status of 1378 children, hospitalized in the infirmary of the Pediatrics Department of a Medical School in Campinas (Brasil), was evaluated using a weight for age criterion with four classes: Eutrophic (E), first, second and third degree malnutrition (M1, M2, M3) with limits Mean (M) minus one Standard Deviation (SD), M-2.5SD and M-4SD. The prevalence of PEM was 66.6% (40.7% Ml, 17.7% M2 and 8.20%/M3). Infectious Pathologies of the Lower Respiratory Tract (IPLRT) and diarrheas are responsible for 24.7% and 18.48% of the Definitive Hospitalization Diagnostic (DHD), being the two groups of pathologies with greatest prevalence. Length of Hospitalization Time (LHT) increases markedly with malnutrition, specially for diarrheas, but E and M1 patients have similar behavior, as well as M2 and M3 ones. M-2.5SD (weight for age) could then be a limit to distinguish "high risk patients".     

7岁以下农村儿童体格发育调查

目的:了解江西省农村儿童体格发育水平及营养不良的患病率。方法:通过整群抽样调查江西省农村9238例儿童,所有儿童均由统一培训人员测量身高、体重,以WHO/NCHS标准为参数评价儿童体格发育水平,计算年龄别身高Z值(HAZ)、年龄别体重Z值(WAZ)和身高别体重Z值(WHZ)。分别计算儿童生长迟缓、低体重、消瘦的患病率。结果:我省农村儿童体格发育水平6月以内可达甚至超过WHO标准,6月龄后开始滞后。6月龄内儿童Z值主要分布在0～1和-1～0两个区间;6月龄后逐渐向左移,Z值主要分布于-1～0和-1～-2两个区间。儿童HAZ和WAZ主要分布在-1～0和-1～-2两个区间;而WHZ则以0～1和-1～0两个区间为主。生长迟缓、低体重和消瘦的患病率分别是13.2%、13.0%和2.9%,出生后6月内营养不良检出率最低,以后随年龄增长检出率逐渐增加,生长迟缓率在18～24月龄时达高峰。结论:我省农村儿童体格发育水平与WHO标准仍有一定差距,提示应进一步提高农村卫生水平和加强健康教育,有效改善农村儿童营养状况。     

Infection palustre et état nutritionnel : résultats d’une cohorte d’enfants âgés de 6 à 59 mois au Kivu en République démocratique du Congo

BackgroundDespite a reduction in the magnitude of endemic malaria reported in recent years, malaria and protein-energy malnutrition (PEM) still remain major causes of morbidity and mortality in sub-Saharan Africa among children under five. The relationship between malaria and malnutrition remains a topic of controversy. We aimed to investigate malaria infection according to nutritional status in a community-based survey.MethodsA cohort of 790 children aged 6 to 59 months and residing in eastern Democratic Republic of the Congo was followed-up from April 2009 to March 2010 with monthly visits. Data on nutritional status, morbidity between visits, use of insecticide-treated nets and malaria parasitemia were collected at each visit. The Z scores height for age, weight for age and weight for height were computed using the reference population defined by the WHO in 2006. Thresholds for Z scores were defined at ?3 and ?2. A binary logistic model of the generalized estimating equation (GEE) was used to quantify the association between PEM indicators and malaria parasitemia. Odds ratio (OR) and their 95% confidence interval (95% CI) were computed.ResultsAfter adjustment for season, children with severe stunting (height for age Z score < ?3) were at lower risk of malaria parasitemia greater or equal to 5000 trophozoits/μL of blood as compared to those in with a better nutritional status (height for age Z score ≥ ?2) (OR = 0.48, 95% CI: 0.25–0.91).ConclusionSeverely stunted children are at a lower risk of high-level malaria parasitemia.     

Alpha-2-macroglobulin, 3-methylhistidine and other biochemical parameters in preschool children of marginal nutritional status. Some evidence of an adaptation process in subclinical protein-energy malnutrition

Anthropometric measurements were taken from 14 preschool children from families with a rather high socioeconomic status in Bangkok and from 14 age-matched village preschool children suffering from or just recovering from subclinical protein energy malnutrition (PEM). Subclinical malnutrition was defined as −2.00 standard deviation (SD) score and below, of weight for height based on an internationally used North American standard from the US National Centre for Health Statistics. The SD scores weight for height and height for age were calculated. The medians of SD scores for both indicators of the nutritional status were found to be statistically significantly lower for the Khon Kaen children compared to their Bangkok counterparts. The serum proteinase inhibitor, alpha₂-macroglobulin (α₂M) concentration was found to be statistically significantly higher and 3-Methylhistidine (3MH) excretion per 24 hours urine significantly lower for the village children compared with both variables derived from the urban children. These findings support the hypothesis that, in a marginal nutritional situation, muscle catabolism is influenced to adjust to actual protein, or protein and energy requirements to intake, by slowing down the metabolic rate. α₂M may be directly or indirectly involved in this process possibly by interacting with the muscle proteases.     

Follow-up of children with moderate or severe malnutrition in the peripheral population (Brazil)]

What happens to children who develop moderate or severe malnutrition? What is done for them? Keeping in mind these questions, the present research was undertaken with the following objectives: to assess the nutritional status of children who develop moderate or severe malnutrition before the age of 5 years, after a period from 2 to 4 years after diagnosis; to assess the nutritional status of the under 5-year old siblings of these children; to study the influence of nutritional programs available in the community for the improvement of the nutritional status of the malnourished children; and to identify factors interfering with nutrition of these children during the study period. After a period of 2 to 4 years from the time of diagnosis of moderate or severe malnutrition the authors tried to locate the families of 61 malnourished children of Porto Alegre, RS (Brazil). The mothers their substitutes were interviewed and the children and siblings under 5 years of age were weighed and measured. Thirty-nine children were located. Of these, 4 (10%) died and 22 (56%) presented an increase of at least 10% in weight for age. Of the 35 children who survived, 29 (82%) still presented some degree of malnutrition (weight/age < or = 90% of the standard), 25 (71%) were stunted (height/age < or = 95%), and 5 (14%) were wasted (weight/height < or = 90%). The nutritional status of the 5-year old siblings was similar to that of the malnourished children.(ABSTRACT TRUNCATED AT 250 WORDS)     

Leptin levels and IgF-binding proteins in malnourished children: effect of weight gain

OBJECTIVES: Although it is well known that leptin reflects body fat content in adults, the regulation of leptin levels during childhood malnutrition is poorly understood. Insulin-like growth factor I (IGF-I) and the IGF-binding proteins (IGFBPs) may play important roles in the regulation of body composition. We investigated the relation between leptin, IGF-I, and IGFBPs in children with protein-energy malnutrition (PEM; before and after recovering 10% of their initial body weights) in comparison with well-nourished children. METHODS: Fifteen PEM and 16 healthy children were studied on admission and after 10% weight gains in the malnourished group. Leptin was measured with radioimmunoassay, IGF-I and IGFBPs were measured with immunoradiometric assay. RESULTS: Patients with PEM had a significantly lower body mass index and percentage of body fat than did the control children. Before weight gain, leptin, IGF-I, and IGFBP-3 were significantly lower and IGFBP-1 was elevated in the malnourished group compared with the control group. Among PEM patients, after 10% weight gains, the levels of leptin, IGF-I, and IGFBP-3 were significantly higher and IGFBP-1 significantly lower compared with the control group. Leptin correlated significantly with IGF-I in the normal children (r(s) = 0.86, P < 0.005). On admission, no correlation was observed between leptin and IGF-I (r(s) = 0.08, P < 0.16) and between leptin and IGFBP-3 (r(s) = 0.02, P < 0.27) in the malnourished group, but those levels improved after 10% recovery of their body weights (r(s) = 0.47, P < 0.002 and r(s) = 0.42, P < 0.005, respectively). In the PEM group, IGF-I correlated significantly with IGFBP-3 when the children gained weight (before: r(s) = 0.006, P < 0.31; after: r(s) = 0.32, P < 0.01). Our study showed results similar to those of anorexia nervosa studies, but the normalization of study variables was obtained in considerable less time for the same weight gain. CONCLUSIONS: The main finding of this study was that, after refeeding with only a 10% weight gain, the PEM children normalized their leptin, IGF-I, and IGFBP-3 levels. These results provide evidence that leptin can function as link between this hormonal response and improved nutrition status.     

Risk factors associated with severe underweight among young children reporting to a diarrhoea treatment facility in Bangladesh

Protein-energy malnutrition (PEM) is a serious health problem among young children in Bangladesh. PEM increases childhood morbidity and mortality. Information is needed on the major risk factors for PEM to assist with the design and targeting of appropriate prevention programmes. To compare the underlying characteristics of children, aged 6-24 months, with or without severe underweight, reporting to the Dhaka Hospital of ICDDR,B in Bangladesh, a case-control study was conducted among 507 children with weight-for-age z-score (WAZ) < -3 and 500 comparison children from the same communities with WAZ > -2.5. There were no significant differences between the groups in age [overall mean+standard deviation (SD) 12.6 +/- 4.1 months] or sex ratio (44% girls), area of residence, or year of enrollment. Results of logistic regression analysis revealed that severely-underweight children were more likely to have: undernourished mothers [body mass index (BMI) < 18.5, adjusted odds ratio (AOR) = 3.8, 95% confidence interval (CI) 2.6-5.4] who were aged < 19 years (AOR = 3.0, 95% CI 1.9-4.8) and completed < 5 years of education (AOR = 2.7, 95% CI 1.9-3.8), had a history of shorter duration of predominant breastfeeding (< 4 months, AOR = 2.3, 95% CI 1.6-3.3), discontinued breastfeeding (AOR = 2.0, 95% CI 1.1-3.5), and had higher birth-order (> 3 AOR = 1.8, 95% CI 1.2-2.7); and fathers who were rickshaw-pullers or unskilled day-labourers (AOR = 4.4; 95% CI 3.1-6.1) and completed < 5 years of education (AOR = 1.5; 95% CI 1.1-2.2), came from poorer families (monthly income of Tk < 5,000, AOR = 2.7, 95% CI 1.9-3.8). Parental education, economic and nutritional characteristics, child-feeding practices, and birth-order were important risk factors for severe underweight in this population, and these characteristics can be used for designing and targeting preventive intervention programmes.     

中国部分农村地区3岁以下儿童营养状况及相关因素研究

目的 了解中国中西部10省农村地区3岁以下儿童的营养状况及其相关影响因素.方法 在10省46个项目县地区采用人口比例(PPS)抽样方法,对230个乡920个村的13 532名3岁以下儿童的营养状况进行了问卷调查和体格发育检测.以年龄别身高(HA)、年龄别体重(wA)和身高别体重(WH)作为衡量儿童营养状况的指标.采用Epi Data 3.02软件建立数据库,采用SPSS 11.5软件进行统计分析.结果 项目地区3岁以下儿童生长迟缓(HAZ＜-2)、低体重(WAZ＜-2)和消瘦(WHZ＜-2)的患病率分别为12.4%、11.8%和5.7%,其中男童高于女童,少数民族高于汉族,西部地区高于东部和北部地区.汉族儿童低体重和生长迟缓的患病率分别为9.5%和9.8%,而少数民族儿童低体重和生长迟缓的患病率分别为15.6%和16.5%,明显高于汉族儿童,差异有统计学意义(P＜0.01).营养不良患病率有随年龄上升趋势,生长迟缓、低体重和消瘦的患病率分别在24月龄、15～30月龄和15月龄达到峰值.HA、WA和WH的Z值分布较NCHS/WHO标准分别向左偏移了0.59、0.60和0.26个单位(P＜0.01),提示儿童整体营养状况均受到不同程度的影响.低体重儿童2周腹泻和感冒的患病率为15.9%和13.5%,分别高于正常体重儿童,差异有统计学意义(P＜0.01).多因素非条件logisitic回归分析显示,6月龄以下儿童生长迟缓主要与母亲是否在家照顾有关;6月龄以上儿童生长迟缓与年龄、性别、民族、排行、母亲文化程度、单独做饭和地区等因素有关;6月龄以上儿童低体重受年龄、民族、母亲文化程度、6～8月龄是否添加鸡蛋和地区等因素的影响.结论 中国中西部农村地区3岁以下儿童的营养不良患病率有随年龄上升的趋势;地区间营养不良患病率差异明显.     

Body composition in early onset eating disorders

BACKGROUND: Body mass index (BMI) or equivalent weight for height indices are the most widely used measures of body composition in early onset and adolescent eating disorders. Although of value as screening instruments the limitation in disease states is their inability to discriminate fat and fat-free components of body weight. OBJECTIVE: To compare height-adjusted fat and fat-free components of body composition in children and young adolescents with different types of eating disorders with those of age matched reference children. DESIGN: Weight, height, triceps and subscapular skinfold thickness were measured in 172 children (aged 7-16 y) with eating disorders receiving specialist treatment. Fat mass index (FMI) and fat-free mass index (FFMI) were calculated using Slaughter's and Deurenberg's equations and normalisation for height. Using data from 157 normal children, representative of the UK 1990 growth reference data, reference curves for FMI and FFMI+/-2 s.d. were derived. Results for patient groups were superimposed on these reference curves. RESULTS: FMI and FFMI were both reduced in eating disorders associated with malnutrition, including anorexia nervosa (AN). AN subjects did not differ from other subjects with comparable degrees of malnutrition. Children with eating disorders of normal weight, such as bulimia nervosa and selective eating, did not differ significantly from reference children in their relative FM and FFM. CONCLUSIONS: FM and FFM merit independent consideration in disorders of malnutrition in children, rather than expressing data as percentage body fat or percentage BMI. The implications of loss of FFM on growth and development merit further investigation.     

Infections associated with severe malnutrition among hospitalised children in East Africa

Severe protein-energy malnutrition (PEM) predisposes affected children to various infections, which either worsens their nutritional status or causes malnutrition, hence complicating their management and outcome. This study was carried out to determine the infections associated with severe malnutrition among children admitted at Kilifi District Hospital (KDH) in Kenya and Muhimbili National Hospital (MNH) in Dar es Salaam, Tanzania. Data was collected from hospital register books and online system database. A total of 1121 children with severe malnutrition were admitted during a period of one year (2004-2005) (MNH = 781; KDH = 340). The proportion of male children with malnutrition was higher than that of female children. Non-oedematous malnutrition was more prevalent at MNH (N = 504; 64%) than KDH (N = 130; 38%). Conversely, oedematous was more prevalence than non-oedematous malnutrition among children admitted at KDH (N = 2 10; 61.7%). More than 75% of all patients with severe PEM were children < 2 years old. Thirty-six per cent of all severe PEM cases had malaria in both hospitals. Forty-five per cent of all admitted patients with severe PEM at KDH had diarrhoea. Two hundred twenty two (28%) and 64 (19%) of the children with severe malnutrition died at MNH and KDH, respectively. Oedematous PEM was associated with a higher case fatality rate than non-oedematous one (P < 0.05). At MNH, 86% of the patients who died with severe malnutrition had other co-morbidities. More (46%) oedematous malnourished patients with co-infections died at MNH than non-oedematous malnourished patients (19%). At KDH, septicaemia was the leading cause of death (55%) among severely malnourished patients. In conclusion, coinfections complicate the management of severe malnutrition and are associated with higher death rate. Management of such infections is of paramount importance to reduce case fatality rates.     

河南省农村HIV阳性产妇分娩婴儿营养状况评价

目的 了解河南省农村地区艾滋病病毒(HIV)感染母亲分娩婴幼儿的营养状况。方法 使用WHO的Anthro 2010软件,分别计算160名婴幼儿在满1、3、6、9、12、18月龄的年龄别体重、年龄别身高、身高别体重Z值评分,以WHO参考人群为标准评估婴幼儿的营养状况。结果 共调查满18月龄存活婴幼儿160人,其中HIV阳性婴幼儿32例,HIV阴性婴幼儿128人;除3月龄以外,HIV阳性婴幼儿低体重发病率均高于HIV阴性婴幼儿(P<0.05);6、12、18月龄HIV阳性婴幼儿的生长发育迟缓率均高于HIV阴性婴幼儿(P<0.05);3月龄以后HIV阴性婴幼儿年龄别体重Z值(WAZ)增长趋势优于HIV阴性婴幼儿(P<0.05),随访期间阴性婴儿WAZ值为-0.59～0.79,阳性婴儿的WAZ值为-1.41～-0.04;年龄别身长Z值(HAZ)2组婴幼儿在9、18月龄差异均有统计学意义(P<0.05);随访期间阴性婴儿HAZ值为-1.22～-0.17,阳性婴儿HAZ值为-1.89～-0.90;HIV阳性产妇分娩的婴幼儿在多个月龄的体重、身高值与正常婴幼儿差异有统计学意义。结论 河南省农村地区HIV阳性产妇分娩婴幼儿的营养不良发病率较高,HIV阳性婴幼儿更为严重。     

New CIMDER measuring tapes for screening nutritional status in children less than 5 years of age

The measurement of mid‐upper arm circumference (MUAC) using CIMDER tapes to assess the nutritional status of children aged 5 years and younger first occurred nearly 40 years ago. In this study, new CIMDER tapes were developed to assess severe and moderate malnutrition, mild malnutrition and, for the first time using the MUAC method, overweight in children aged less than 5 years, based on the World Health Organization (WHO) MUAC (2006) reference standards. The tapes were developed for boys and girls and specified for four age ranges: 3–6 months, 6.1–18 months, 18.1–36 months and 36.1–60 months. The weight, age and MUAC of 1283 children were assessed to evaluate the accuracy and concordance of the new CIMDER tapes with the WHO weight‐for‐age reference standards. The new CIMDER tapes were found to have good accuracy and concordance with the WHO weight‐for‐age reference standards across all age and sex groups. These results suggest that the new CIMDER tapes can be used in place of WHO weight‐for‐age growth charts for screening nutritional status of children less than 5 years of age, including for risk of malnutrition and overweight.     

Physical growth and neurointegrative performance of survivors of protein--energy malnutrition.

1. The anthropometric measurements and neurointegrative performance of seventy-nine children aged 6--12 years who had survived kwashiorkor in early childhood were compared to those of 142 children who served as controls. 2. For the boys the differences in height and weight between those who had survived protein--energy malnutrition (PEM) and the controls were significant (P less than 0.01). 3. For the girls the differences in height and weight between those who had survived PEM and the controls were not significant. 4. In the tests chosen, the performances of the survivors of PEM was significantly poorer than that of the controls. 5. There was no improvement in the performance when thirteen survivors were reassessed at 10 years of age. 6. There was a significant difference in scholastic performance between the survivors of PEM and the normal controls. The scholastic performance of the siblings of PEM survivors was also significantly better than that of the PEM survivors. 7. The dietary intakes at the time of reassessment were unsatisfactory in 25% of the survivors, but did not relate to their scholastic abilities.     

Amélioration de la gestion d’un programme de suivi de la croissance à base communautaire des enfants en milieu rural au Rwanda

BackgroundIn order to improve the management of a community based nutrition program in the catchment area of Ruli District Hospital in Rwanda, we carried out a nutrition survey to determine the risk factors for childhood malnutrition in the area. Identifying the groups of children at risk of malnutrition and their risk factors allows the community nutrition workers to target the children who require close monitoring, and assists in the development of key messages for educational nutrition training.MethodsThe prevalence of the three forms of malnutrition was estimated by using the Z-scores height for age, weight for age and weight for height with NCHS/OMS/2000 reference. Logistic regression was performed to identify the risk factors for malnutrition.ResultsOur findings show that children from 12–35 months of age are at greatest risk of malnutrition. Risk factors for wasting include: low monthly income of the household, concurrent illness of the child and a household that does not practice breeding. Risk factors for underweight include: child being greater than 12 months of age, mother of the child being pregnant and history of malnutrition in the household. Finally, risk factors for stunting include the absence of a mosquito net in the household, an insufficient number of working adults in the household, the child being greater than 12 months of age and a household managed by a man alone or by an orphan.ConclusionCommunity based growth monitoring must focus its attention on the children from nine to 35 months of age. Children less than nine months of age are generally followed by the health centers through the immunization program, and the older children are generally followed in the child minder schools that need to be promoted in all the cells. Community messages must focus on the identified risk factors of malnutrition, and a positive deviance approach must be introduced in the entire zone.